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OBJECTIVES:
Advances in drug therapy for rheumatoid arthritis (RA) have been encouraging us to preserve the metatarsopharangeal (MTP) joint in correction of forefoot deformities, and original metatarsal shortening offset osteotomy was recommended as one of the conventional surgical options for forefoot deformities in RA cases. The objective of this study was to evaluate short- to mid-term outcomes of modified metatarsal shortening offset osteotomy.
METHODS:
A retrospective observational study was completed for 80 RA cases (mean follow-up period: 3.2 years) who underwent modified metatarsal shortening offset osteotomy. Both lesser toe scales and RA foot ankle scales were administered using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and a postoperative self-administered foot evaluation questionnaire (SAFE-Q) at final follow-up was also checked to evaluate clinical outcomes.
RESULTS:
This procedure significantly improved clinical scores of both the JSSF [lesser toes and RA foot and ankle] scales. Of 80 feet, 24 (30%) showed recurrence of MTP joint subluxation/dislocation. Furthermore, the feet in the recurrence group showed significant varus hindfoot. On the other hand, valgus foot in the recurrence group more frequently included midfoot bony ankyloses. All of the affected feet showed the limitation of MTP joints (<70°) after surgery.
CONCLUSIONS:
Modified metatarsal shortening offset osteotomy was recommended for RA forefoot disorders as one of the joint preservation surgeries in short- to mid-term follow-up. However, some modifications to avoid limitation of ROM in the MTP joint are required. It must be borne in mind that varus hindfoot and/or bony ankyloses in the mid-hindfoot can cause recurrence of dorsal dislocation/subluxation of the lesser toe MTP joint.

Background:
Recurrent pain and deformity following forefoot surgery can cause significant patient disability. In patients with rheumatoid arthritis, first metatarsophalangeal (MTP) joint arthrodesis with lesser metatarsal head resections—termed the rheumatoid forefoot reconstruction—has been shown to be a reliable operation for pain relief and deformity correction. Limited data, however, have been published on outcomes of the same forefoot reconstruction operation in the nonrheumatoid patient. Here, we describe our experience with this procedure in patients without rheumatoid disease, hypothesizing improved clinical and radiographic outcomes following surgery.

Conclusion:
With decreased pain, high satisfaction rates, and improved radiographic parameters, first MTP arthrodesis coupled with lesser metatarsal head resection was a viable option for nonrheumatoid patients who failed prior attempts at forefoot reconstruction or have chronic forefoot pain with deformity

Aim
We determined ankle pathologies in patients with different types of inflammatory rheumatic diseases using high-resolution ultrasonographic (US) images, and compared the findings among the different patient groups.
Methods
The study included 142 randomly selected inflammatory rheumatic disease patients with clinically swollen or painful ankle joints; 69 patients had rheumatoid arthritis (RA), 58 had spondyloarthropathies (SpA) and 15 had gout. Ankle assessment on US included all of the important anatomical structures. The foot function of patients was evaluated using the Foot Function Index (FFI).
Results
Among all the patients, 98.6% of joints were tender and 72.9% were swollen; 82.1% joints were pathological on US. Tibiotalar joint synovitis was observed significantly more frequently in the SpA and gout patients (P < 0.05). Tibialis posterior (TP) tenosynovitis was significantly more common in the RA group than in the other groups (P < 0.001). Subtalar and talonavicular joint synovitis were observed more frequently in the early RA group compared to the other groups (P < 0.05). Tibiotalar joint synovitis was observed more frequently > 1 year after RA diagnosis (P < 0.05). Subtalar joint synovitis, TP tenosynovitis, and peroneus tenosynovitis were the best predictors of higher FFI scores in patients with RA (R2c = 0.360, F = 11.83, P < 0.000).
Conclusion
Tendon involvement in our RA patients was observed more frequently than has been previously estimated. TP tenosynovitis appears to be more specific for RA, while Achilles tendinitis is more frequent in axial SpA and reactive arthritis. Tibiotalar joint involvement exhibits a time-dependent significant increase in frequency in patients with RA.

BACKGROUND:
Disease-related foot pathology is recognised to have a significant impact on mobility and functional capacity in the majority of patients with rheumatoid arthritis (RA). The forefoot is widely affected and the metatarsophalangeal (MTP) joints are the most common site of symptoms. The plantar plates are the fibrocartilaginous distal attachments of the plantar fascia inserting into the five proximal phalanges. Together with the transverse metatarsal ligament they prevent splaying of the forefoot and subluxation of the MTP joints. Damage to the plantar plates is a plausible mechanism therefore, through which the forefoot presentation, commonly described as 'walking on pebbles', may develop in patients with RA. The aims of this study were to investigate the relationship between plantar plate pathology and clinical, biomechanical and plain radiography findings in the painful forefoot of patients with RA. Secondly, to compare plantar plate pathology at the symptomatic lesser (2nd-5th) MTP joints in patients with RA, with a group of healthy age and gender matched control subjects without foot pain.
METHODS:
In 41 patients with RA and ten control subjects the forefoot was imaged using 3T MRI. Intermediate weighted fat-suppressed sagittal and short axis sequences were acquired through the lesser MTP joints. Images were read prospectively by two radiologists and consensus reached. Plantar plate pathology in patients with RA was compared with control subjects. Multivariable multilevel modelling was used to assess the association between plantar plate pathology and the clinical, biomechanical and plain radiography findings.
RESULTS:
There were significant differences between control subjects and patients with RA in the presence of plantar plate pathology at the lesser MTP joints. No substantive or statistically significant associations were found between plantar plate pathology and clinical and biomechanical findings. The presence of plantar plate pathology was independently associated with an increase in the odds of erosion (OR = 52.50 [8.38-326.97], p < 0.001).
CONCLUSION:
The distribution of plantar plate pathology at the lesser MTP joints in healthy control subjects differs to that seen in patients with RA who have the consequence of inflammatory disease in the forefoot. Longitudinal follow-up is required to determine the mechanism and presentation of plantar plate pathology in the painful forefoot of patients with RA.

OBJECTIVE:
We aim to discuss the association of isolated atrophy of the abductor digiti quinti muscle in patients with rheumatoid arthritis as well as review the anatomy and imaging findings of this condition on MRI.
MATERIALS AND METHODS:
A consecutive series of 55 patients diagnosed with rheumatoid arthritis according to the 2010 ACR/EULAR classification criteria were recruited. MRI of the clinically dominant feet was performed using a 1.5-T scanner.
RESULTS:
The study population was predominantly female (94.5%), and the age range was 31-79 years (mean 57.5 ± 11). A total of 55 ankles were examined by MRI, and 20 patients (36.3%), all females, showed abductor digiti quinti denervation signs. Seven patients demonstrated severe fatty atrophy of the abductor digiti quinti, corresponding to Goutallier grade 4, 2 patients showed moderate fatty atrophy (Goutallier grade 3), and the remaining 11 patients showed less than 50% fatty atrophy, corresponding to a Goutallier grade 2. Substantial agreement was found for both intra- and interobserver agreement regarding the Goutallier grading system.
CONCLUSION:
Prevalence of signs of abductor digiti quinti denervation on MRI was high in the studied population, suggesting that rheumatoid arthritis may be associated with inferior calcaneal nerve compression.

Aim: Pedobarographic analysis may be employed to quantify
foot function, however, the value of pedobarographic analysis
as a diagnostic tool for the screening of recently diagnosed
Rheumatoid Arthritis (RA) patients remains uncertain. The aim of
this systematic review was to: a) assess the different instruments
used to analyse plantar pressure; b) to report on the technical
considerations associated with manual and automatic masking
and c) to assess the validity together with the inter- and intraobserver
reliability of pedobarographic analyses for identification
of pathological profiles in patients suffering with RA.
Method: Following the PRISMA guidelines, a literature
search was undertaken using a variety of computerised
bibliographic databases. The Quality Appraisal of Diagnostic
Reliability was employed to assist in the analysis of reliability.
Results: A review and analysis of the literature found only
20 papers with relevant reliability and accuracy.
Conclusion: The literature concerning the validity and
reliability of pedobarography in the screening for early onset
foot deformities in RA patients has not been proven. Although
the forefoot has been identified as a common area of the
plantar surface where deformities occur in RA, there are very
few studies that demonstrate any subtle changes that could
forecast forefoot deformities in asymptomatic RA patients.

Aim of this work The aim of this study was to investigate the pattern and prevalence of forefoot bursae (FFB) and their effect on foot functions in Egyptian patients with rheumatoid arthritis (RA).
Patients and methods The study included 100 patients with RA diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria. The patients were recruited from the outpatient clinic of Physical Medicine, Rheumatology and Rehabilitation Department in Alexandria Faculty of Medicine. Musculoskeletal ultrasound (US) of the forefeet under the standardized EULAR guidance was done for all patients, and accordingly, the studied patients were further classified as those with US-detectable FFB (group I) and those without US-detectable FFB (group II). For group I patients, foot impact scale (FIS), foot anatomical changes assessment, and gait analysis were done.
Results US-detectable FFB was found in 92% of the 100 patients with RA. The most frequent intermetatarsal bursa was the fourth one, and the most frequent submetatarsal bursa was the first one. There was a statistically significant relation between the total number of FFB on one side and its two subscales, meta-tarsophalangeal synovial hypertrophy, serum C-reactive protein level, visual analogue scale of foot pain, and step length on the other side. No statistically significant correlation was found between the total number of FFB and BMI, clinical disease activity index, or the foot deformities. Moreover, no statistical significant correlation was found between FIS and clinical disease activity index.
Conclusion US-detectable FFB are highly prevalent in patients with RA and considered a significant contributory factor to foot disability among these patients. Foot disability may occur regardless of the RA activity state.